Increasing blood glucose variability is a precursor of sepsis and mortality in burned patients.

Alexander N Pisarchik,Olga N Pochepen,Liudmila A Pisarchyk,Stefano Boccaletti

doi:10.1371/journal.pone.0046582

Abstract

High glycemic variability, rather than a mean glucose level, is an important factor associated with sepsis and hospital mortality in critically ill patients. In this retrospective study we analyze the blood glucose data of 172 nondiabetic patients 18–60 yrs old with second and third-degree burns of total body surface area greater than 30% and 5%, respectively, admitted to ICU in 2004–2008. The analysis identified significant association of increasing daily glucose excursion (DELTA) accompanied by evident episodes of hyperglycemia (>11 mmol/l) and hypoglycemia (<2.8 mmol/l), with sepsis and forthcoming death, even when the mean daily glucose was within a range of acceptable glycemia. No association was found in sepsis complication and hospital mortality with doses of intravenous insulin and glucose infusion. A strong increase in DELTA before sepsis and death is treated as fluctuation amplification near the onset of dynamical instability.

Highlights

A human organism, as a very complex dynamical system, is characterized by various variables and parameters, and as in any real system, a certain level of noise always presents
Group 1 In this group of survivors without sepsis, the blood culture was negative, while hyperglycemia was present at admission and lasted only one day, that is associated with high cortisol (677 (640–820) nmol/l) (r = +0.35) and insulin (444 (260–760) pmol/l) (r = +0.38) levels
Hyperglycemia immediately after trauma (‘‘ebb phase’’) in all patients is associated with hypovolemia, hypoxia, a decrease in oxygen delivery, and tissue perfusion. (Note that the patients who died due to a burn shock in the first three days after trauma were excluded from this research)

Summary

Introduction

A human organism, as a very complex dynamical system, is characterized by various variables and parameters, and as in any real system, a certain level of noise always presents. In 1985 Wiesenfeld and McNamara [10,11] hit upon an idea that a dynamical system near the onset of a dynamical instability (critical point) might be very sensitive to coherent or random perturbations. They showed that both periodic and random fluctuations are greatly amplified in the vicinity of different bifurcations, such as saddle-node, transcritical, pitchfork, period doubling, and Hopf. According to the WiesenfeldJs theory [10], prebifurcation noise amplification can serve as a precursor of a bifurcation in a nonlinear dynamical system; the closer to the critical point the system gets, the stronger noise amplification

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